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Table of Contents
ORIGINAL ARTICLE
Year : 2016  |  Volume : 4  |  Issue : 2  |  Page : 26-31

Study of clinical and microbial profile of infections in type 2 diabetes mellitus


1 Resident, Department of General Medicine, C U Shah Medical College & Hospital, Dudhrej road, Surendranagar, Gujarat, India
2 Resident, Department of Microbiology, C U Shah Medical College & Hospital, Dudhrej road, Surendranagar, Gujarat, India
3 Assistant Professor, Department of General Medicine, C U Shah Medical College & Hospital, Dudhrej road, Surendranagar, Gujarat, India
4 Associate Professor, Department of General Medicine, C U Shah Medical College & Hospital, Dudhrej road, Surendranagar, Gujarat, India

Date of Web Publication30-Aug-2018

Correspondence Address:
M M Sheta
Resident, Department of Microbiology, C U Shah Medical College & Hospital, Dudhrej road, Surendranagar, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2347-6486.240198

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  Abstract 


Introduction: Diabetes mellitus predisposes to infection. Clinical data on infections in diabetes mellitus patients from rural areas of India are lacking. We intended to determine the clinical profile and pattern of infections in type 2 diabetes mellitus patients in rural area.
Methods: This prospective observational study was conducted in type 2 diabetes patients admitted in Medicine department at a tertiary care hospital from December 2014 to November 2015.
Results: In this study, 627 patients with diabetes mellitus admitted during December 2014 to November 2015 were observed. Out of these 627 patients 263 had various types of infections. Maximum number of patients belonged to age group of 46 to 60 years and there was male predominance. The commonest comorbidity was hypertension (51.33 %). Common infections encountered were urinary tract infection (40.30 %), respiratory tract infection (28.90 %) and Skin and soft tissue infections (12.93 %). Escherichia coli, Candida, Klebsiella pneumonaie and Staphylococcus aureus were the common causative organisms of all these infections.
Conclusion: Physicians should be aware of risk factors and type of infections present in patients with diabetes in order to provide proper care and for their prevention.

Keywords: Diabetes mellitus, Infections, Risk factor, Tuberculosis, UTI


How to cite this article:
Adroja C G, Sheta M M, Shah S I, Sonagara M J. Study of clinical and microbial profile of infections in type 2 diabetes mellitus. J Integr Health Sci 2016;4:26-31

How to cite this URL:
Adroja C G, Sheta M M, Shah S I, Sonagara M J. Study of clinical and microbial profile of infections in type 2 diabetes mellitus. J Integr Health Sci [serial online] 2016 [cited 2022 Aug 9];4:26-31. Available from: https://www.jihs.in/text.asp?2016/4/2/26/240198




  Introduction Top


Diabetes mellitus (DM) is a common non communicable disease in India. The prevalence of type 2 DM is 11 % in urban areas and 3 - 9 % in rural areas.[1] Infections play a significant role in morbidity and mortality of diabetic patients.[2] Studies have revealed that defect in the function of neutrophils, lymphocytes, and monocytes were the reason for increased infections in diabetics.[3],[4] Other reasons are low levels of leucotriene B4, thromboxane B2, and prostaglandin E.[5],[6] Some studies showed decreased lymphocyte function and decreased phagocytosis by monocyte in diabetics.[7],[8] There is also evidence that improving glycemic status in diabetics, improves cellular immunity.[9] Although DM is very common in India, studies on various types of infections in patients with DM from rural Indian areas are lacking. Therefore, the aim of this study was to explore this problem in our own setup.


  Methodology Top


Aim of the study was to find out various infections and also to identify their causative microorganism from hospitalized patients having type 2 diabetes mellitus. After approval from institutional ethics committee, this prospective observational study was conducted in type 2 diabetes patients admitted in medicine department at a tertiary care hospital from December 2014 to November 2015. All type 2 diabetes patients admitted were enrolled in the study. All the patients were subjected to routine investigations and to investigations to identify presence of infection. A culture of the infected tissue was done to isolate the microorganism responsible. All study data were entered in predesigned format and analyzed by using SPSS version 17.


  Results Top


During the study period of one year, there were total 627 type diabetes mellitus patients admitted in the medicine department. Out of these 627 patients, 263 (41.95 %) people suffered from various infections. These 263 type 2 diabetes mellitus patients with various infections were included in the study.

[Table 1] indicates that infections in patients with diabetes mellitus were more in age group between 46-60 years.
Table 1: Age wise distribution of patients. (n=263)

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In our study, hypertension was the most common co morbid condition while second common co morbidity was cardiovascular disease other than hypertension [Table 2].
Table 2: Number of patients with different co morbidity

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In our study, hypertension was the most common co morbid condition while second common co morbidity was cardiovascular disease other than hypertension [Table 2].

Most common infections encountered in this study were urinary tract infection [Table 3].
Table 3: Number of patients with different type of infections.

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Escherichia coli were the most common causative organisms [Table 4].
Table 4: Number of patients with different organisms.

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  Discussion Top


Patients with DM have been associated with increased rate of infections compared with patients without DM.[10],[11],[12] Early diagnosis and aggressive treatment of infections in these vulnerable patients is clinical priority. Several parts of immune system are altered in diabetic patients. Multiple functions of leukocyte like adherence, chemotaxis, and phagocytosis are affected.[3],[4],[13] Rate of infection in diabetics is low in developed countries compared to developing countries like India.[14] Out of 627 DM patients, 263 (41.95 %) had evidence of infections. In our study maximum numbers of cases were in 46 to 60- year age group. This increase in incidence of infection with age was observed in Gillani et al. study.[15] In this study 176 (66.92 %) patients were males. Gender differences between men and women in the development of foot infections have been observed in other studies.[16],[17]Prevalence of UTI in diabetics increased 1.9-fold with each 10-year increase in diabetes duration.[18] We observed similar finding of more UTI cases in our study. Hypertension and cardiovascular diseases were the most prevalent co morbidities in our study. However, from our data it cannot be concluded that these conditions predispose to infection, since a control population group was not studied. Among the diabetics who had infection, UTI was found in highest number of patients (40.30 %). Infections caused by certain microorganisms (Staphylococcus aureus, gram negative organisms) occur with increased frequency in diabetics.[19] Pneumococcal pneumonias is associated with increased mortality in DM patients.[20] Staphylococcus aureus and Klebsiella pneumonia were the most common microorganisms causing respiratory tract infections in our studied patients. Majority of UTI cases in our study were asymptomatic. Eschericia coli and Candida were the common causative organisms.

Several studies have showed a higher incidence of bacteriuria in DM patients than non- diabetics.[21],[22],[23] DM is a common risk factor for urinary tract infection caused by fungi, particularly Candida species.[24] DM patients are more prone for severe infections of the upper urinary tract.[25] Complications also occur more frequently in DM patients than in non DM patients with urinary tract infections.[26] In one study Escherichia coli was the commonest cause of urinary tract infection.[27] Our study showed similar finding.

In this study 34 (12.93 %) DM patients had skin infections. Among the diabetics who had skin lesions, fungal infection was more common. Rest of skin infections were due to bacterial invasions. Same results are found by Foss NT, et al.[28]

In our study 16 (6.08 %) patients had tuberculosis. Several studies showed that tuberculosis is more common in DM patients.[29],[30],[31],[32] Multiple factors like hyperglycemia, glycosylation, long term oxidative stress, cell medicated immune dysfunctions and genetic determinants contribute to the susceptibility of severe tuberculosis in diabetes.[29],[31] Patients presented with pyrexia of unknown origin and infection invading GI tract as well as nervous system.


  Conclusion Top


The study showed that patients with type 2 DM are at increased risk for common infections. Therefore, it is essential to provide health education to promote good glycemic control. Long term hygiene care and maintenance of normal health may prevent infective complications in DM patients.



 
  References Top

1.
Park; Park’s Textbook of preventive and social medicine. 23th edition, M/s Banarsidas Bhanot, Jabalpur, 2014: 341-5.  Back to cited text no. 1
    
2.
Muller LM, Gorter KJ, Hak E, Goudzwaard WL, Schellevis FG, Hoepelman AI, Rutten GE. Increased risk of common infections in patients with type 1 and type 2 diabetes mellitus. Clinical infectious diseases. 2005 Aug 1;41(3):281-8.  Back to cited text no. 2
    
3.
Gallacher SJ, Thomson G, Fraser WD, Fisher BM, Gemmell CG, MacCuish AC. Neutrophil bactericidal function in diabetes mellitus: evidence for association with blood glucose control. Diabetic medicine. 1995 Oct 1;12(10):916-20.  Back to cited text no. 3
    
4.
Delamaire M, Maugendre D, Moreno M, Le Goff MC, Allannic H, Genetet B. Impaired leucocyte functions in diabetic patients. Diabetic Medicine. 1997 Jan 1;14(1):29-34.  Back to cited text no. 4
    
5.
Jubiz W, Draper RE, Gale J, Nolan G. Decreased leukotriene B4 synthesis by polymorphonuclear leukocytes from male patients with diabetes mellitus. Prostaglandins, Leukotrienes and Medicine. 1984 Jun 1;14(3):305-11.  Back to cited text no. 5
    
6.
Qvist R, Larkins RG. Diminished production of thromboxane B2 and prostaglandin E by stimulated polymorphonuclear leukocytes from insulin-treated diabetic subjects. Diabetes. 1983 Jul 1;32(7):622-6.  Back to cited text no. 6
    
7.
Kolterman OG, Olefsky JM, Kurahara C, Taylor K. A defect in cell-mediated immune function in insulin-resistant diabetic and obese subjects. The Journal of laboratory and clinical medicine. 1980 Sep;96(3):535-43.  Back to cited text no. 7
    
8.
Geisler C, Almdal T, Bennedsen J, Rhodes JM, KØLendorf K. Monocyte functions in diabetes mellitus. APMIS. 1982 Nov 1;90(1-6):33-7.  Back to cited text no. 8
    
9.
Joshi N, Caputo GM, Weitekamp MR, Karchmer AW. Infections in patients with diabetes mellitus. New England Journal of Medicine. 1999 Dec 16;341(25):1906-12.  Back to cited text no. 9
    
10.
Shah BR, Hux JE. Quantifying the risk of infectious diseases for people with diabetes. Diabetes care. 2003 Feb 1;26(2):510-3.  Back to cited text no. 10
    
11.
Calvet HM, Yoshikawa TT. Infections in diabetes. Infectious disease clinics of North America. 2001 Jun 1;15(2):407-21.  Back to cited text no. 11
    
12.
Pozzilli P, Leslie RD. Infections and diabetes: mechanisms and prospects for prevention. Diabetic Medicine. 1994 Dec 1;11(10):935- 41.  Back to cited text no. 12
    
13.
Valerius NH, Eff C, Hansen NE, Karle H, Nerup J, Søeberg B, Sørensen SF. Neutrophil and lymphocyte function in patients with diabetes mellitus. Acta Medica Scandinavica. 1982 Jan 12;211(6):463-7.  Back to cited text no. 13
    
14.
Zargar AH, Masoodi SR, Laway BA, Akhter MA; Incidence and Pattern of Infections in Diabetes Mellitus a Retrospective Study. Int J Diab Dev Countries., 1994; 14:82-4.  Back to cited text no. 14
    
15.
Syed Wasif G, Syed Azhar Syed S, Shameni S. Prediction and rate of infections in diabetes mellitus patients with diabetes ketoacidosis in Penang, Malaysia. Open Journal of Epidemiology. 2012 Feb 17; 2:1-6.  Back to cited text no. 15
    
16.
Young BA, Maynard C, Reiber G, Boyko EJ. Effects of ethnicity and nephropathy on lower-extremity amputation risk among diabetic veterans. Diabetes care. 2003 Feb 1;26(2):495-501.  Back to cited text no. 16
    
17.
Lavery LA, Armstrong DG, Vela SA, Quebedeaux TL, Fleischli JG. Practical criteria for screening patients at high risk for diabetic foot ulceration. Archives of internal medicine.1998 Jan 26;158(2):157-62.  Back to cited text no. 17
    
18.
Keane EM, Boyko EJ, Reller LB, Hamman RF. Prevalence of asymptomatic bacteriuria in subjects with NIDDM in San Luis Valley of Colorado. Diabetes care. 1988 Oct 1;11(9):708-12.  Back to cited text no. 18
    
19.
Koziel H, Koziel MJ. Pulmonary complications of diabetes mellitus. Pneumonia. Infectious disease clinics of North America. 1995 Mar;9(1):65-96.  Back to cited text no. 19
    
20.
Woodhead MA, Macfarlane JT, McCracken JS, Rose DH, Finch RG. Prospective study of the aetiology and outcome of pneumonia in the community. The Lancet. 1987 Mar 21;329(8534):671-4.  Back to cited text no. 20
    
21.
Kass EH. Bacteriuria and the diagnosis of infections of the urinary tract: with observations on the use of methionine as a urinary antiseptic. AMA archives of internal medicine. 1957 Nov 1;100(5):709-14.  Back to cited text no. 21
    
22.
Hansen R. Bacteriuria in Diabetic and Non-diabetic Out-patients. Journal of Internal Medicine. 1964 Jan 12;176(6):721-30.  Back to cited text no. 22
    
23.
Vejlsgaard R. Studies on urinary infection in diabetics. Journal of Internal Medicine. 1966 Jan 12;179(2):173-82.  Back to cited text no. 23
    
24.
Singh CR, Lytle Jr WF. Cystitis emphysematosa caused by Candida albicans. The Journal of urology. 1983;130(6):1171-3.  Back to cited text no. 24
    
25.
Forland M, Thomas V, Shelokov A. Urinary tract infections in patients with diabetes mellitus: studies on antibody coating of bacteria. Jama. 1977 Oct 31;238(18):1924-6.  Back to cited text no. 25
    
26.
Wheat LJ. Infection and diabetes mellitus. Diabetes care. 1980 Jan 1;3(1):187-97.  Back to cited text no. 26
    
27.
Edelstein H, Mccabe RE. Perinephric abscess: modern diagnosis and treatment in 47 cases. Medicine. 1988 Mar 1;67(2):118-31.  Back to cited text no. 27
    
28.
Foss NT, Polon DP, Takada MH, Foss-Freitas MC, Foss MC. Skin lesions in diabetic patients. Revista de saude publica. 2005 Aug;39(4):677-82.  Back to cited text no. 28
    
29.
Root HF; The association of diabetes and pulmonary tuberculosis. N Engl J Med., 1934; 210:192-206.  Back to cited text no. 29
    
30.
Centers for Disease Control-screening for tuberculosis and tuberculosis infection in high risk population and the use of preventive therapy for tuberculosis infection in the United States: Recommendations of the Advisory Committee for Elimination of Tuberculosis: MMWR, 1990; 39; 1-2.  Back to cited text no. 30
    
31.
Swai AB, McLarty DG, Mugusi F. Tuberculosis in diabetic patients in Tanzania. Tropical doctor. 1990 Oct;20(4):147-50.  Back to cited text no. 31
    
32.
Patel JC. Complications in 8793 cases of diabetes mellitus 14 years study in Bombay Hospital, Bombay, India. Indian journal of medical sciences. 1989 Jul;43(7):177-83.  Back to cited text no. 32
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]


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